THE COST OF PREGNANCY ALONE You are having a baby. Why are we so stressed? Post-delivery mental health

By Dr Naeem Mohammed   Iqubal Dalal

A concerned family who just had their first baby asked. “Ba Doctor, My wife has been failing to look after the baby we just had. She has been looking forward to having our son throughout pregnancy. But it has been 2 months since she delivered and she has changed. She is not her usual self and stopped communicating”  

Did you know that up to 85 % of women experience some type of mood change after delivery (post-partum period). The pregnancy period and delivery is a major life event which for many women ends up as the most stressful period of their life. For most women the behavioral changes/features (symptoms) are temporary and mild; however, some women experience a more disabling and persistent form. Although post delivery mood disorders are relatively common, Low mood/unhappy (depressive symptoms) behavior that emerges after delivery are frequently overlooked by mothers. This often leads both the mother and baby at risk.

Prevention is the best medicine. There is need to understand what Post-delivery blues are and how to treat them. Post delivery is a time of increased risk for the development of mental health illness in women.

Mental health illness occurring within the first year after childbirth, especially when the behavioral features are present after the first 4 weeks after delivery raises concern.

The growing of mood challenges following days and weeks after delivery is often overlooked or ignored by mothers due to lack of awareness. It is considered normal in our community and at times an attitude problem. Less than one-third of women with post delivery illness seek professional help.

In post delivery women, mental illness is typically divided into three categories: (1) Baby blues/Post delivery blues, (2) Post-delivery depression, and (3) Post delivery loss of reality/perceptions (psychosis). There may be significant overlap between these three subtypes.

“WHY HAS MY WIFE BEEN AFFECTED? IS SHE POSSESSED BY A DEMON?”

After a women delivers, significant body (physiological) and mind (psychosocial) changes occur. The impact of psychosocial factors in the development of mood weakness during the post delivery period cannot be underestimated. Given the multiple factors explained below it is not straight forward to point out who will experience mood disturbance.  Age, marital status, number of children, education level, and socioeconomic status (financial support). All these have a role to play. High rates of post delivery depression is a common finding in young (adolescent) mothers. At Chainama, it is a common trend and records reveal that first time mothers are more vulnerable to post delivery mental illness than mothers who have previously delivered. Mothers who undergo various complications at the time of delivery (e.g., prolonged labor, emergency/unplanned caesarean section, stillbirth) are at increased risk of depression.

Stressful life events during pregnancy or near the time of delivery appear to increase the likelihood of weakened mental health. One of the most consistent findings is that among women who report marital or inadequate social support which is the case in many Zambian women (who have poor social support from communities and family or unplanned pregnancies), are more prone to post delivery depression.

CLINICAL FEATURES TO LOOK OUT FOR.

Baby Blues: (post delivery blues) occur within the first week after delivery. (30 to 85 %) Women with baby blues report a variety of symptoms, including lack of interest, mood fluctuation, irritability, tearfulness, uneasiness and insomnia (poor sleep pattern or inability to sleep). These symptoms typically peak on the fourth or fifth day after delivery and go away by the tenth day. Blues are time-limited. While the occurrence of baby blues does not necessarily reflect an illness in the mother, some women with blues will go on to develop depression. Especially if it lasts more than a month.

Post Delivery Depression: Major depressive illness is relatively common after one undergoes pregnancy and delivery. (Range of 10 to 15 %.) While some women report the sudden low mood shortly after delivery, Low mood commonly develops gradually over the first 6 months after delivery. Many women actually experience the onset of low mood symptoms during pregnancy. The signs and symptoms are low mood, irritability, lack of interest in usual liked hobbies and activities, poor sleep habits, and feeling weak with lack of energy are frequently reported. Negative feelings toward the baby are noted among mothers. It is common for a woman to express doubt or concerns about her ability to care for her child. In its most severe form, it may result in complete loss of interest. (The mother detaches herself from everything) Suicidal thoughts are also of concern among many mothers.

“WILL MY WIFE GET BETTER?”

As post delivery blues are usually mild in severity and resolve spontaneously, no medical treatment other than support and reassurance is required.  Although the symptoms may be distressing, they typically do not affect the mother’s ability to function and to care for her baby. Mothers should be instructed to visit the nearest health posts. Or primary care provider if the symptoms persist longer than two weeks to ensure the early identification of a more severe illness. Mothers require family and social support to get past this period.

Post delivery Depression demands the same treatment as depression that occurs at other times; the earlier the treatment is initiated, the better the outcome.

Non Medical Therapy: Counselling therapies are frequently used in the treatment of depression. Inter-personal family counselling therapy (social support, relationship support with the spouse, and interaction with the baby.) Cognitive-behavioral therapy which focus on issues specific to new mothers with depression, Such as the inability to cope with the demands of caring for a child, perceived lack of support and absence of enjoyable activities.

Medical Therapy: Mood stabilisers, and Antidepressant medications are available and proven to help improve the mental strength. Inpatient Hospitalisation In cases of severe depression may be required. Particularly for mothers who are at risk for suicide.

It is not possible to reliably predict which women in the general population will experience post delivery mood disturbance however we can look out for signs by asking a pregnant women the following:

Are you okay?

Are you ready for delivery?

Have you been to your antenatal reviews?

Have you and your spouse discussed your delivery options?

Are you afraid of labor? Who is your support system?

Are you financially ready to support a baby?

What are your plans after having your baby?

Do you feel you need help to take care of your baby after you deliver?

 In summary, the need for awareness of pregnancy and the emotional burden it has on the pregnant women needs to be understood.

It is not just the physical changes that one needs to focus on in todays fast evolving reality but also the psychological and social factors that need to be taken care of during pregnancy. It is not a one man show and it is not just about having a baby. It is a lot more. Get involved and lets help take the stigma away from mental health. Lets Talk Mental Health. A healthy mind equals to a healthy body.

The author is a Zambian Mental health advocate at Chainama Hospital.

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